Seattle's Leaders Let Scientists Take the Lead. New York's Did Not | The New Yorker
Category: News & Politics
Via: thomas • 4 years ago • 26 commentsBy: Charles Duhigg (The New Yorker)
Interesting article presenting a compelling argument for getting the politicians out of the way.
S E E D E D C O N T E N T
The initial coronavirus outbreaks on the East and West Coasts emerged at roughly the same time. But the danger was communicated very differently.
By Charles Duhigg
April 26, 2020 Seattle's approach to COVID-19 mirrored E.I.S.'s guidelines. New York's did not.
______________________________________________________________
The first diagnosis of the coronavirus in the United States occurred in mid-January, in a Seattle suburb not far from the hospital where Dr. Francis Riedo, an infectious-disease specialist, works. When he heard the patient's details—a thirty-five-year-old man had walked into an urgent-care clinic with a cough and a slight fever, and told doctors that he'd just returned from Wuhan, China—Riedo said to himself, "It's begun."
For more than a week, Riedo had been e-mailing with a group of colleagues who included Seattle's top doctor for public health and Washington State's senior health officer, as well as hundreds of epidemiologists from around the country; many of them, like Riedo, had trained at the Centers for Disease Control and Prevention, in Atlanta, in a program known as the Epidemic Intelligence Service. Alumni of the E.I.S. are considered America's shock troops in combatting disease outbreaks. The program has more than three thousand graduates, and many now work in state and local governments across the country. "It's kind of like a secret society, but for saving people," Riedo told me. "If you have a question, or need to understand the local politics somewhere, or need a hand during an outbreak—if you reach out to the E.I.S. network, they'll drop everything to help."
Riedo is the medical director for infectious disease at EvergreenHealth, a hospital in Kirkland, just east of Seattle. Upon learning of the first domestic diagnosis, he told his staff—from emergency-room nurses to receptionists—that, from then on, everything they said was just as important as what they did. One of the E.I.S.'s core principles is that a pandemic is a communications emergency as much as a medical crisis. Members of the public entering the hospital, Riedo told his staff, must be asked if they had travelled out of the country; if someone had respiratory trouble, staff needed to collect as much information as possible about the patient's recent interactions with other people, including where they had taken place. You never know, Riedo explained, which chance encounter will shape a catastrophe. There are so many terrifying possibilities in a pandemic; information brings relief.
A national shortage of diagnostic kits for the new coronavirus meant that only people who had recently visited China were eligible for testing. Even as EvergreenHealth's beds began filling with cases of flulike symptoms—including a patient from Life Care, a nursing home two miles away—the hospital's doctors were unable to test them for the new disease, because none of the sufferers had been to China or been in contact with anyone who had. For nearly a month, as the hospital's patients complained of aches, fevers, and breathing problems—and exhibited symptoms associated with COVID-19, such as "glassy" patches in X-rays of their lungs—none of them were evaluated for the disease. Riedo wanted to start warning people that evidence of an outbreak was growing, but he had only suspicions, not facts.
At the end of February, the C.D.C. began allowing the testing of patients with unexplained respiratory-tract infections or "fever and/or symptoms of acute respiratory illness." Riedo called a friend—an E.I.S. alum at the local department of health. If he sent her swabs from two patients who had needed ventilators but had tested negative for influenza and other common respiratory diseases, would she test them for COVID-19? At that point, there had been only sixteen detections of the coronavirus in the U.S., and only the one in Washington State. "I can't remember why we picked those two patients," Riedo told me. "I was sure they'd be negative. But we thought it would be good to start collecting data, and it was a way to make sure the testing lab was working." The health official told him to send the samples to her lab.
Riedo remembered that other local researchers had been conducting a project called the Seattle Flu Study. For months, they had collected nasal swabs from volunteers, to better understand how influenza spread through the community. During the previous few weeks, the researchers, in quiet violation of C.D.C. guidance, had jury-rigged a coronavirus test in their lab and had started using it on their samples. They had just found a positive hit: a high-school student in a suburb twenty-eight miles from Seattle, with no recent history of foreign travel and no known interactions with anyone from China. The boy wasn't seriously ill; if the researchers hadn't done the test, the infection probably never would have been detected. The genetic sequence of the boy's virus was unnervingly similar to that of the man with the first known case, even though the researchers couldn't find any connections between them. The frightening implication was that the coronavirus was already so widespread that contagion was passing invisibly among community members.
At seven-forty that evening, Riedo got a call from his friend at the public-health lab. Both of the samples he had sent were positive. Riedo sent over swabs from nine other EvergreenHealth patients. Eight were positive. Riedo grabbed the patients' charts and saw that seven of them had come from the Life Care nursing home. It didn't make any sense: nursing-home residents don't travel, and interact mainly with just family members and staff.
Riedo sent in more samples. Most of the patients tested positive, including a woman who had been told that she had pneumonia, another woman who had complained of sweating and clammy hands, and a man in his fifties with serious respiratory problems. For three days, dozens of that man's family members had sat at his bedside in the hospital, coming in and out of the building and going from home to work, visiting restaurants and shaking people's hands, inadvertently exposing themselves and others to COVID-19.
At that moment, there were no known U.S. coronavirus fatalities. Schools, restaurants, and workplaces were open. Stock markets were near all-time highs. But when Riedo stopped to calculate how many of his hospital employees had been exposed to the coronavirus he had to quit when his list surpassed two hundred people. "If we sent all of those workers home for two weeks, which is what the C.D.C. was recommending, we'd have to shut down the entire hospital," he told me. He felt like a man who, having casually swatted at a buzzing insect, suddenly realized that he was beneath a beehive.
The next day, the man with all the family visitors died. It was America's first known COVID-19 death. Riedo called his wife. "I told her I didn't know when I would be coming home," he said to me. "And then I started e-mailing everyone I knew to say we were past containment. It had already escaped."
Epidemiology is a science of possibilities and persuasion, not of certainties or hard proof. "Being approximately right most of the time is better than being precisely right occasionally," the Scottish epidemiologist John Cowden wrote, in 2010. "You can only be sure when to act in retrospect." Epidemiologists must persuade people to upend their lives—to forgo travel and socializing, to submit themselves to blood draws and immunization shots—even when there's scant evidence that they're directly at risk.
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More than fifteen thousand people in New York are believed to have died from COVID-19. Last week in Washington State, the estimate was fewer than seven hundred people. New Yorkers now hear constant ambulance sirens, which remind them of the invisible viral threat; residents are currently staying home at even higher rates than in Seattle. And de Blasio and Cuomo—even as they continue to squabble over, say, who gets to reopen schools—have become more forceful in their warnings. Rasmussen said, "It seems silly, but all these rules and SOHCOs and telling people again and again to wash their hands—they make a huge difference. That's why we study it and teach it." She continued, "It's really easy, with the best of intentions, to say the wrong thing or send the wrong message. And then more people die." ♦
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A small tale of Seattle. One of my employers has an office there. 5 or 6 people who have all been sick off and on for months.
They refuse to get tested, they just try to work through it. Finally the office manager said work from home or not at all.
If she goes in she sprays everything with Lysol.
One guy goes in at 5AM leaves when the owner shows up at 1pm.
They hired a new guy 2 weeks ago. He lasted until this past Tuesday went home with a fever and a cough, found his wife
also home with fever and cough. They have COVID.
They are young and will probably be fine, but this is going to keep repeating for months and months.
It might but it also goes back to personal responsibility. The guy and his wife who came down with COVID probably picked it up from being around others and not taking the proper precautions, especially if the guy that comes in at 5 is fine.
Either way, I hope the couple is fine.
BTW, did anyone try to drink or inject any of the lysol the employer had in the office?
Asking for a friend
Well, I'm not sure you can blame NY. The first case was on March 1. It was a healthcare worker who self-isolated when she found out she had the virus. The second case was the one that bit us on March 3rd.
On March 3, a second case was confirmed, a lawyer in his 50s who lived in New Rochelle , Westchester County , immediately north of New York City , and worked in Midtown Manhattan . [14] He had traveled to Miami in February, but had not visited areas known to have widespread transmission of the coronavirus. Two of his four children had recently returned from Israel. After first feeling ill on February 22, he was admitted to a hospital in Westchester on February 27, diagnosed with pneumonia , and released from isolation after testing negative for the flu . [15] [16] Instances of panic buying in New York were reported after his case was confirmed. [17]
On March 4, the number of cases in New York State increased to 11 as nine people linked to the lawyer tested positive, including his wife, a son, a daughter, a neighbor, and a friend and his family. [18] On March 5, Mayor de Blasio said that coronavirus fears should not keep New Yorkers off the subway , riding from Fulton Street to High Street in a public press attempt to demonstrate the subway's safety. [19] On March 6, eleven new cases were reported, bringing the state caseload to 33. [20] All the new cases were tied to the first community transmission case, the lawyer. [21] At the end of the day, an additional 11 new cases were reported by the governor, bringing the total caseload to 44, with 8 of the new cases in Westchester County, and 3 in Nassau County on Long Island. [22] Also on March 6, an article appeared in the New York Post stating that while Mayor de Blasio assigned responsibility for the lack of N95 masks and other personal protective equipment to the federal government, the city never ordered the supplies until that date. [23]
On March 7, Governor Andrew Cuomo declared a state of emergency in New York after 89 cases had been confirmed in the state, 70 of them in Westchester County, 12 in New York City and 7 elsewhere. [24] On March 8, the state reported 16 new confirmed cases and a total of 106 cases statewide. [25] New York City issued new commuter guidelines amid the current outbreak, asking sick individuals to stay off public transit, encouraging citizens to avoid densely packed buses, subways , or trains. [26]
On March 9, New York City mayor Bill de Blasio announced that there were 16 confirmed cases of COVID-19 in New York City. [27] On March 10, Governor Cuomo announced a containment zone in the city of New Rochelle from March 12 to 25. [28]
On March 11, Cuomo announced that the City University of New York and State University of New York schools would be closed for the following week, from March 12 to 19. These college systems would move most classes to an online-based system starting March 19, and continuing through the rest of the spring semester. Dormitories will remain open for students "who cannot return home for hardship reasons." [29]
On March 11, a man in Monroe County tested positive, making it the first county in Western New York to have a COVID-19 case. [30] Officials said he flew into JFK from Italy , traveled on a Greyhound bus from Manhattan to Rochester, and arrived locally the morning of March 10. The bus continued on to Buffalo and Toronto . [31] On March 12, the first two cases were confirmed in Albany County , leading Albany mayor Kathy Sheehan to suspend the annual St. Patrick's Day parade . [32] The same day, a staff member at Union College tested positive for coronavirus in Schenectady County , marking the county's first case. [33]
On March 13, Herkimer County saw its first confirmed case but declined to disclose the patient's location. The patient later was revealed to have been from the Mohawk / Ilion area , just south of Herkimer , the county seat . [34] On March 14, the first two fatalities in the state occurred. An 82-year-old woman in Brooklyn with pre-existing emphysema died in the hospital. [35] A 65-year-old person with other significant health problems who had not previously been tested for COVID-19 died at their home in Suffern , Rockland County . [36] It was also announced that three people in Erie County tested positive for COVID-19. [37]
On March 15, the third fatality in the state was announced. A 79-year-old woman with underlying health issues died, who had been admitted to a New York City hospital. [38] On March 16, Clinton County reported its first case, at CVPH Medical Center in Plattsburgh . No further information has been revealed about the patient. [39] Confirmed cases increased by 4,000 between March 22 and 23, which brought the total number of confirmed cases statewide to nearly 21,000. [40] 12,305 of these were in New York City. [41] On March 24, Cuomo stated that "The apex is higher than we thought and the apex is sooner than we thought." He warned there was not enough assistance from the federal government and that the state had 25,000 cases and at least 210 deaths. [42] 211 NYPD officers and civilian employees have tested positive for COVID-19. In total, 2,774 NYPD employees, 7.6 percent of the workforce, were sick. [43]
On March 26, Cuomo announced that the state would allow two patients to share one ventilator using a technique he called "splitting," where a second set of tubes would be added to the ventilator. COVID-19 patients need ventilators for between 11 and 21 days, while under normal circumstances patients usually only require them for three to four days. He also said the state was considering converting anesthesia machines to use as ventilators. [44] Between March 25 and March 26, there were 100 deaths statewide, with the number of hospitalized patients increasing by 40 percent in New York City. [45]
So I would like someone to point out where New York dropped the ball other than the not closing the subways.
I was not really blaming any one person, but I was noting the different responses and outcomes. In Seattle, and Washington in general, there is a greater willingness to actually listen to what someone else is telling you without looking for the sucker punch that you are sure you are going to get if you are from New York. I have lived in both places and had this Non-trustingness pointed out to me. (Of course, in Seattle you can get done talking and the person to whom you are talking might just smile, turn, and walk away.) It is all about attitude .
This general difference in attitude might be partially responsible for the way the people acted, but it is of more certainty that this attitude played a bigger part in DiBlasio and Cuomo's reactions. Also, the politicians, because they are politicians, are looking out for and seeing the same information through a different lens. It really is a good article. You should read it. Also read about the coronavirus circulating through communities well before we thought it was, even as early as mid February and probably earlier. We will be able to tell with increased testing.
From he article:
There is more to the article at the seed and it really is quite good.
Perrie might like this. I’m going to come to the defense of New Yorkers for a change.
TL;DR: I don’t like this story.
So many assumptions and there’s no way to prove any of it to be true - especially at this early stage.
The headline here is that in Plato’s Republic fashion, scientists should be in charge and politicians only muck it up. That sounds like fanboy talk to me. Buried in the story are the multiple unconsidered factors that make an outbreak in one city or state very different from another.
Ya think? I would guess that’s a YUGE factor. But back to slamming NYC . . .
So they’re shittier people and they brought it on themselves with their shitty attitudes? Nice.
Also HUGE factors (and not anyone’s fault) buried in the story. Let’s not talk about them too much, though, because we need to get back to blowing scientists. But first, the final straw:
AKA you have no idea why the differences manifest and no way to predict how one city will do versus another. Turns out it’s a crap shoot, after all!
Sometimes, there is a lot of pretentious bullshit in fancy writing published in sophisticated rags.
The presence of uncertainty stated in the article in no way makes the article any less valid. If you wish to discuss valid points about the article, feel free. If you are just going to take pot shots at it and dismiss it out of hand, then go away. In no way have I or the article slammed New Yorkers. The fact is, while the healthcare community was raising the alarm, politicians were trying to make sure that the business and population remained calm, which, in the case of New York looked more like "nothing is wrong"
So, if I disagree with your article, my points aren’t valid? And if I don’t agree with it, I should go away? Sorry, but that’s not how it works. You put something up, it gets picked apart and criticized.
And I didn’t dismiss it out of hand. I quoted the article and said precisely what I found wrong with it.
I didn’t say anything about you, so don’t even try to go there. Phony victimization claims get laughed at. The article, however, does slam New Yorkers and I cited precisely where it does that. It specifically makes a sweeping generalization about the character of New Yorkers (aka a stereotype) and blames the spread of disease on that alleged facet of their character.
If you disagree with the article, state where and why you disagree. As you so succinctly pointed out, I am free to disagree and tell you why. It works both ways.
If you look down the thread, I posted a thorough rebuttal to your post @5.3. If you care to respond to that, go right ahead.
I did. All you have to do is read.
Phony people and phony indignation get laughed at also, so why don't you respond to my critique of your argument?
I am a New Yorker and I have lived 6 years in Seattle, so I know what I am talking about when I say that there is a difference, generally speaking, in attitude between people who grew up in the Northeastern region of the country and people who grew up in the upper left hand corner. And, by the way, no New Yorker that I know would take the line that you quoted from the article as proof of a shitty character, they would just laugh and say,"Yeh. Sounds 'bout right." Further, the second part of your statement that the article, " ... blames the spread of disease on that alleged facet of their character ," is patently false.
Here is the paragraph that you used to get your quotes, in it's entirety:
So, no it does not. Just plain no. The article looks at much more than you accuse it of, takes many factors into account, focuses on the arguably more controllable messaging and communication aspect, and shows the real difference between the two responses in terms thereof. That was the point, and you missed it.
I really don't think that you read any further than that, which is a shame.
Here is your participation prize
I see no reason to debate the issue when your comments are so full of personal attacks. It's clear that you will just be angry with me if I don't agree with everything in the article. Have a nice day.
I was waiting for a response that actually addressed the article substance, which you did, kind of, in your first post, even if it did seem that you were more interested in proving that the article had no worth because it was published in the New Yorker.
Here's your line:
It is interesting that perceived slights against you are considered personal attacks, while you feel free to slight me, to put words into my mouth and then argue against them, not me. I have actually addressed the points that you have made, rather than pissing on the article and the magazine in which it was published.
Funny how you posted that but cannot actually back it up. Pick away. I wont roll over and play dead. If you actually make a good point, I will gladly point that out. If I feel your point is incorrect, I will tell you that also. That is what I did to your comment. That is called online debate. That is what happens here.
If you walk into a bar and tell the bouncer that his girlfriend looks sleazy and that you don't like the music, it is almost a surety that you are looking for a fight. I don't see why you would not expect some pushback.
It is interesting that this article is about communication, because you seem to want to be heard, but only if you can gain the upper hand and basically be a bully. When your bluff is called, you run away crying about your feelings being hurt.
Oh, that is you in the picture...
If the shoe fits....
Oh? When did I slight you? Did you write the article? Congratulations on being published in The New Yorker. But even then, the comment you have a problem with was aimed at the content of the article and at The New Yorker magazine in general. Not at you and not at the author personally.
On the other hand, you took shots directly at me.
Also, the following is not true.
Not only have I not put words in your mouth, but other than this stupid slap fight you started, I haven't been interested in discussing your comments at all. I commented on the article. Period. End of story. My opinion has nothing to do with you.
Back up what exactly? That seeds get commented on? Criticized? I can't imagine how that could be controversial. Why would it need to be "backed up? What do you think goes on around here?
No one said you had to.
I did not come seeking your approval.
Your feelings for an article in The New Yorker equate to that level of personal relationship?
Nope. Not trying to do any such thing. Just popped by to give my two cents. But your panties are in a huge bunch over it. That's your problem, not mine. Now you've wrecked your own seed by making the whole thing about me. What a waste!
What bluff? This is some real fantasy stuff you're into now. I have no idea what you're talking about.
And another personal attack from you. Why? There's no reason for it.
More of the same. Do you have a point?
The first substantive line of your initial post:
Right there you are flat wrong, they are considered but the article concentrates on communication. If you read the whole article you would realize that the article is about communication, at least I should hope you would.
Your first comment posted ended with :
Hence my analogy of the bouncer at the bar. But you feign obtuseness so that you can attempt to make me look thin skinned. To Wit:
And in 5.1.1
I never said that. I rebutted your points in 5.3.
I also never claimed to be a victim:
I rebutted your argument at 5.3 and you have as of yet to address that rebuttal. I can only assume that, since you refuse to answer my rebuttal, you have no answer and are merely trolling for fun.
Listen, aside from from your initial post, which I have rebutted, you have added precisely nothing to the conversation except to whine and jeer and otherwise be obnoxious and time consuming, so: No substance + pure bullshit = Goodbye.
I made all my points, but since I have nothing else going on right now, I am happy to summarize them.
The article makes assumptions it can’t support with evidence, such as scientists are better communicators and New Yorkers are more sick than people in Seattle because of their character. This is also called stereotyping, which is something we should try to avoid. It’s also bullshit as scientific analysis.
As an afterthought, I saw this convoluted thinking as typical of the kind of writing one sees in the The New Yorker. The New Yorker is a magazine that insists on itself. It publishes skilled writers that unfortunately often write pretentious nonsense. It actually has something of a reputation for this among some folks. Other people see it as a reliable source of wit and wisdom. To each his own. I can attack the source if I like. It’s ridiculous for you to be personally insulted by that.
All my other points have been in response to personal attacks from you. I have tried to talk you back from the ledge, but you won’t let it go. Thus from you:
Classy.
when i'm fortunate enough to get some elitist to shine my shoes with one of these "sophisticated rags", i try to not spit on the Shoe Shine Boy.
One never do know,
when one will get to witness
the Underdog Show, and prey tell, when it doesn't work out well, as knot all
are like Sweet Polly, on Molly, while Pure and Bred till buttered, R
On Oh K shun, telling of the TRUTH, instead of the Trump words from Hell,
but , O well, asz sum prefer to variably dwell
Cause we is yes in French and knowledge isn't always Smart,
to repell ,
but, like takin a chance on a non pol, WHAT THE HELL
So we just have to throw out anything that is said because it can't be proven? Bye bye NT then, because that is pretty much most of what that I see on this site: Opinions masquerading as fact, stretched to the elastic limits of (il)logic and fallacious arguments delivered in a mean spirited and specious way. At least on the news page.
No, the headline is about communication of risk, what to do about that risk, and comparing two different ways that were taken to do the same. That is the information that I wished to convey by posting the story.
You say the information was buried in the story. No. Wrong. It was not 'Buried", it was contained in the story to give a more complete picture and to make the reader aware of exactly that information. I have stated more than once to read the whole story. I did, and my takeaway from the story is that politicians have different prerogatives than do the those in health care community. During an outbreak of infectious disease, because of those differing prerogatives, the different messaging that comes out confuses the situation and as such, the politicians in the particular instance of an outbreak should cede the microphone to someone who is an expert and has been trained to communicate effectively or, at the very least, listen to what those people are trying to communicate. FYI: "Go out. Have a beer and see a movie," was not the communication intended by these individuals.
Nowhere will you hear your mis-characterization of New Yorkers either in the story or from me. Once again you are alluding to something that the story does not say.
Your next quote and comment from the story is a repeat of the burial meme which I will not address further except to give it the designator "BM" as a means for future reference.
That is not what the quote is saying at all, but to those with limited reading comprehension skills it might seem to equate. I mean, you can't really expect a disease modeling professional to say that disease modeling has no basis in reality, which is what you said right up there.
No doubt there is. This article, however, is neither pretentious nor bullshit, regardless of your characterization of it as such. Does it say something that you don't want to hear? I cannot say for sure, but your wording suggests that you may have a blind spot for facts presented in sophisticated rags and factual scientific information. If so, that is your loss. One can debate on the substance of an article, but it does little good to try and make an article say what it does not and attempt to argue from that point.